Dataset Information

Assessment of Myocardial CZT SPECT Recording in a Forward-Leaning Bikerlike Position.

ABSTRACT: This prospective randomized study assessed myocardial perfusion imaging with the high-sensitivity D.SPECT cadmium-zinc-telluride camera in a forward-leaning bikerlike position, which may potentially lower diaphragmatic attenuation and reduce breathing-related cardiac motion, in a manner comparable to the prone position proposed with other SPECT cameras. Methods: Patients referred for a stress-rest 99mTc-sestamibi protocol and positioned in the biker position, with the chest leaning forward on the D.SPECT camera-head at 35° from vertical, had an additional resting D.SPECT recording in the supine position (n = 40) or in the sitting position with the back rearward at 30° from vertical (n = 40). Segments with attenuation artifacts were defined as those with less than 65% uptake but with strictly normal contractility at gated SPECT and no defect reversibility from stress images. Results: The biker position was associated with lower heart-to-detector distances than the supine or sitting positions (both P < 0.001); lower cardiac motion amplitudes, assessed on panograms, than the supine position (P < 0.001); and fewer segments with attenuation artifacts than the supine position (on average, 1.10 ± 1.01 vs. 1.90 ± 1.74, P = 0.010) or the sitting position (0.75 ± 0.93 vs. 1.38 ± 1.60, P = 0.011). Conclusion: Myocardial perfusion images from D.SPECT are enhanced for patients positioned in a forward-leaning bikerlike position comparatively to sitting or supine positions, with a notably lower rate of attenuation artifacts.

SUBMITTER: Perrin M

PROVIDER: S-EPMC6581225 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Assessment of Myocardial CZT SPECT Recording in a Forward-Leaning Bikerlike Position.

Perrin Mathieu M Roch Véronique V Claudin Marine M Verger Antoine A Boutley Henri H Karcher Gilles G Baumann Cédric C Veran Nicolas N Marie Pierre-Yves PY Imbert Laetitia L

Journal of nuclear medicine : official publication, Society of Nuclear Medicine 20181102 6

This prospective randomized study assessed myocardial perfusion imaging with the high-sensitivity D.SPECT cadmium-zinc-telluride camera in a forward-leaning bikerlike position, which may potentially lower diaphragmatic attenuation and reduce breathing-related cardiac motion, in a manner comparable to the prone position proposed with other SPECT cameras. <b>Methods:</b> Patients referred for a stress-rest <sup>99m</sup>Tc-sestamibi protocol and positioned in the biker position, with the chest lea ...[more]

PMID: 30389818

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Project description:The aim of this study was to evaluate the reproducibility of myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurement in patients referred for dynamic SPECT. Methods: We retrospectively analyzed patients referred for myocardial perfusion imaging. SPECT data were acquired on a cadmium zinc telluride-based pinhole cardiac camera in list mode using a stress (251 ± 15 MBq)/rest (512 ± 26 MBq) 1-d 99mTc-tetrofosmin protocol. Kinetic analyses were done with software using a 1-tissue-compartment model and converted to MBF using a previously determined extraction fraction correction. MFR was analyzed and compared globally and regionally. Motion detection was applied, but not attenuation correction. Results: In total, 124 patients (64 male, 60 female) were included, and SPECT acquisitions were twice reconstructed by the same nuclear medicine board-certified physician for 50 patients and by 2 different physicians for 74. Both intra- and interobserver measurements of global MFR had no significant bias (-0.01 [P = 0.94] and 0.01 [P = 0.67], respectively). However, rest MBF and stress MBF were significantly different in global left ventricular evaluation (P = 0.001 and P = 0.002, respectively) and in the anterior territory (P < 0.0001) on interuser analysis. The average coefficient of variation was 15%-30% of the mean stress MBF if the analysis was performed by the same physician or 2 different physicians and was around 20% of the mean MFR independently of the processing physician. Using the MFR threshold of 2, we noticed good intrauser agreement, whereas it was moderate when the users were different (κ = 0.75 [95% CI, 0.56-0.94] vs. 0.56 [95% CI, 0.36-0.75], respectively). Conclusion: Repeated measurements of global MFR by the same physician or 2 different physicians were similar, with an average coefficient of variation of 20%. Better reproducibility was achieved for intrauser MBF evaluation. Automation of processing is needed to improve reproducibility.

Project description:BackgroundWith the appearance of cadmium-zinc-telluride (CZT) cameras, dynamic myocardial perfusion imaging (MPI) has been introduced, but comparable data to other MPI modalities, such as quantitative coronary angiography (CAG) with fractional flow reserve (FFR) and positron emission tomography (PET), are lacking. This study aimed to evaluate the diagnostic accuracy of dynamic CZT single-photon emission tomography (SPECT) in coronary artery disease compared to quantitative CAG, FFR, and PET as reference.Materials and methodsDifferent databases were screened for eligible citations performing dynamic CZT-SPECT against CAG, FFR, or PET. PubMed, OvidSP (Medline), Web of Science, the Cochrane Library, and EMBASE were searched on the 5th of July 2020. Studies had to meet the following pre-established inclusion criteria: randomized controlled trials, retrospective trails or observational studies relevant for the diagnosis of coronary artery disease, and performing CZT-SPECT and within half a year the methodological references. Studies which considered coronary stenosis between 50% and 70% as significant based only on CAG were excluded. Data extracted were sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Quality was assessed with QUADAS-2 and statistical analysis was performed using a bivariate model.ResultsBased on our criteria, a total of 9 studies containing 421 patients were included. For the assessment of CZT-SPECT, the diagnostic value pooled analysis with a bivariate model was calculated and yielded a sensitivity of 0.79 (% CI 0.73 to 0.85) and a specificity of 0.85 (95% CI 0.74 to 0.92). Diagnostic odds ratio (DOR) was 17.82 (95% CI 8.80 to 36.08, P < 0.001). Positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.86 (95% CI 2.76 to 5.38, P < 0.001) and 0.21 (95% CI 0.13 to 0.33, P < 0.001), respectively.ConclusionBased on the results of the current systematic review and meta-analysis, dynamic CZT-SPECT MPI demonstrated a good sensitivity and specificity to diagnose CAD as compared to the gold standards. However, due to the heterogeneity of the methodologies between the CZT-SPECT MPI studies and the relatively small number of included studies, it warrants further well-defined study protocols.

Dataset Information

Assessment of Myocardial CZT SPECT Recording in a Forward-Leaning Bikerlike Position.

Publications

Assessment of Myocardial CZT SPECT Recording in a Forward-Leaning Bikerlike Position.

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